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ASPEN46PITKIN
ENVI NMENTAL HEALTH DEPARNMENT
10 #26'13-142-0-01,
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0, a O OD I
TYPE OF PERMIT:
( )initial Construction
( )fmcrgonty Use KRepair Nork, (Piovious Permit 1 1JOA16.) ( )Alteration of an existing system.
of Installation (previous
revloun Pcrmlc /
( )Use Permit as a result of Selo )Othon
ISSUED TO: DATE OF ISSUE -.2Z 0,
Home Phone 923 -yd/ 9 Business
Mailing
Address
Mailing
Address
Sewage Disposal System Work to be performed by ST0TSMA4 - /�)j EBA Z 1
This permit /valid
�opn ley for premises location by the following legal dcecrlptionc /'i �� �Q�� 8,
LtYf 5{EE+ ( Al�/�C NATER SUPPLY �E� AVE-�PERCOLA ION RATE WIN M/,,�� /VC .
This Individual Sewage Disposal Permit is granted with regard to the following uset�LIC FAMI(,Y RutI)EAICE
NW.'Wr oft Dodicems ;?- L.O(Ls 0 Carbage DisposalsDishwashersDishwashers_L Clothes Nashora
AG
CALCULATED AVERAGE DAILY WASTE LOAD 2 1 O GALLONS. -
THE NATURE OF THE SYSTEM
INCLUDED UNDER THIS PERMIT:
Ty» of Tank or Treatment Unit&SEP71C. rig Tank Capn !ty -0 _Gallon mini.
mathnd of final Disposals G5EPAGle (✓jW-' Absorption Area Square Fest minimum
Description �(including brand name, If any) of other equipment or,appuctnaneost
�1/1vG
Other Conditions or Specifiestionsc
J�IDr�e
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
1 )Before Excavation ( )Upon completion of excavation and prior to placement of gravel
lA Prior to backfill of any component ( )Other, Specify, _—_
Before covering dist:ibutlon
sy.tem of abso,rti:m field
Plana and specifications of the proposed sewage disposal system have b>en reviewed and are considered satisfactory. Perm s+Aon
is hereby grar.Lod to tl,n owner or his agent to perfnrm the wrk imlicated above in accordance with the Pitkin ioc:.ty Individual
Srwa;c DLspesai Re•:nlations in effect on the d.,te of issue. In addition to general provisions set fort) on tl,.- reverse Iver-ef,
this Permit is suhleet to the following additional terms and conditions:
i• .
APPROVED FOR ISSUE BY� (title) ----
Tho clove inalv/dwal sc:,age disposal system installed byl7L'/C Zv l)
1 has b,•rn ln.:Pe cted tot use by a reprrsentatwe of the Asl:en l'it to Ce-Lrnn.,l,ta
re::Ivens:bLILLy in case of tatlure or inad gvacy of th v sew .j. dispu sal system.
DATE 0' INAL SVECT N Q -
fl/y,�Cer 130'S�`uth Galena Street Aspen, Colorado 81
%/771 AT -A ll. -oc ✓
Complete as -built drawing attachod.
TITLE
B11 303 925-2020
V4
0 ASPEN&PITKIN
ENVIRONMENTAL HEALTH DEPAR LENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL- PERMIT
Name of OWNER U.I�C�`i7S PHONE �Z3
Address of OWNER
Name of
PERMIT TO BE: KPlcked up
LOCATION OF PROPOSED SYSTEM
SYSTEM
Legal Description 4 P u
C
( )Mailed tog
{ )owner 0gAApplleant
"f t- �- Cs 1czi t-�` )
1 Pv CCDI PHONE
TFPt OF PERMIT, ( )New Installation (moi FRepalr
I )Emergency Use { )Alteration NOT due to failure
Sloe], Filing Subdivision Size of Lot acres
TYPE OF STRUCTURE: �4'1 ogle Family Dwelling ( )Other: Do you plan any further additions to the
residence? ( )YES OO
No. of bedrooms_ No, of Lofts No. of Garbage Disposals k No. of Automatic Dishwashers
No. of Automatic Clothes Washers
WATER SUPPLY: VWrivate well, Depth or ( )Public, Name of System
)Spring
( )Stream or Creek -
TYPES OF INDIVIDUAL SEWACE DISPOSAL SYSTEM PROPOSED:
(,)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other:
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department (925-2020. 8:30-9:30 a.m.)
before a permit can be issued. The individual sewage disposal permit must be issued before a building permit can be obtained.
FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an in dual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above Information
to true and that fall Sn ormatio will invtlid�e ppll c({t ion and any subsequent permit.
{�
Signature of Applicant 11 _ ..I)I DATE
(This application becomes. invalid 12 months from the above data.)
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
2. Proposed and existing water wells on subject property and
adjacent property.
3. Domestic water service lines.
{. Proposed and existing buildings, driveways, and other
structures.
5. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems on subject _
property.
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
The %; hereby hereby acknowledges receipt of this individual new ege disposal perm t ap ieation and a p7t fel3 in the amount
Receipt Number Date res Received , 71 • hY //SCG/
TT Administrative officer
138 South Galena Street Aspen, Colorado 61611 303/925.-2020
7 1
ALPINE CONSTRUCTION CO., INC.4ieI 0
PAY
T,') THE
,:)Ell
C�
LOO 0 d `5 5 (fptli—
Jc6
FIRST NATIONAL BANK -ASPEN
ALPINE CONSTRUCTION CO., INC. oe81 ASPEN, CO 81611
728 EAST HOPKINS AVENUE 9257007 82-164-1021
ASPEN, COLORADO 81611
24625
24625
DATE AMOUNT
11.02462511' 1:10 2 10 164 51: 007 182 311'
DOLLARS
• i
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
yS /!
/Z ,i
PHONE
IQ& -t-
Zir
TEST HOLE No.1
TEST HOLE No. 2 TEST HOLE No. 3
17L
Drop
Time
/1 41,
Drop Time Drop Time
a
SO
5
V/to
e -1 —105
/S
Percolation Rate Each Hole
Average Rate it/"'f s�
Comments on soil or site:
Siwature
Date 2 -9-k?
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I HAROLD W. JOHNSON,(JOHNSON-LONGFELLOW 8 ASSOCIATES INC.)
A REGISTERED SURVEYOR IN THE STATE OF COLORADO, DO HEREBY
CERTIFY THAT ON THE IITH DAY OF JAN. 1983,1 INSPECTED THE
PROPERTY SHOWN HEREON AND FOUND THE IMPROVEMENTS TO
BE AS SHOWN ON THIS PLAT.
JOHNSON —LONGFELLOW 9 ASSOC. INC.
HAROLD WL_lL "HNSON L.S. 9018
."v�r avct�ta. ,
I, HAROLD W.JOUNS(JN,(JOUNSON -LONGFELLOW 6A-550CIATE5,IN
2EG.15TERED SURVEY021N-rwE STATE OFCOLORODO: DO HEREBY
CE2TIFY TNAT ON THE 19TH DAY OF MAQCII, 19-7co, A SURVEY WAS MADE
UNOE2 MV 012ECT SUPERVISION OF THE PQOPEQTY S"0WN WE1 eEON
ANO Two'A' 17RAME 61JILOINGS WEtZE FOUtVD "TO 6E LoCATED EQ-
TIRELY WI_rWIIQ THE LOT Ll,NES. ALiE4SEMEt ITS o2ENCROACLI-
MENT5INEVIDENCE ORVCNOVJNTOME 02E S"OWtJ. SA10SU2VEY
15 12UE ,ACCURATE- -110 TLIE BEST OF MY KNOWLEDGE Ati0 ESE_
LIEF
JUtatJ50N LONGFELLOWB AS50GIATE5,INC.
L1LROLO w Jp>r-1NSsOn.Y L-5. 9018
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TI -{AT ON THE 21 ST pC]Y OF N.)SUS"T, 19-Tg. I INSPECTED TF -{E PRc' EQw a-1Jd4N
NL,t2EON L\ I:D FC7JN0 TN IMPF2GIEMENTS TO EE Lit) �NJN SIJ TF IIS PLdT
J0t4"!Z- J-LONGFELL01" �S�fJC1C�TES,ING.
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JOB NO. 30-004 RECERTIFIED 1 -II -1983
• � 'P80 -2C0 4EVISED & fZEVISED L�UGUST 25.I`�T£i
1 M P20VEMENT SURVEY
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tv A RE01S7ERED SURYEY'ON IN T�-iE STA -r' �,t ' )LCRAP DO HE EBY
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